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General NPI Number Information
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NPI Number | 1093095713
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Entity Type | Individual
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Provider Name | JANET AGNES BLIVEN
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Gender | Female
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 1119 OWENS ST N
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City | STILLWATER
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State | MN
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Zip | 55082-4316
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Country | US
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Telephone | 651-275-8364
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Fax |
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Provider Business Mailing Address
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Address Line | 487 BLUEBIRD DR N
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City | HUDSON
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State | WI
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Zip | 54016-6821
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Country | US
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Telephone | 715-549-6182
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A1200
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1654-19
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License Number State | WI
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